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Cameron KL, Peck KY, Davi SM, Owens CRBD, Svoboda CRSJ, DiStefano LJ, Marshall SW, de la Motte SJ, Beutler CRAI, Padua DA. Association Between Landing Error Scoring System (LESS) Items and the Incidence Rate of Lower Extremity Stress Fracture. Orthop J Sports Med 2022; 10:23259671221100790. [PMID: 35706554 PMCID: PMC9189539 DOI: 10.1177/23259671221100790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Lower extremity stress fracture injuries are a major cause of morbidity in physically active populations. The ability to screen for modifiable risk factors associated with injury is critical in developing injury-prevention programs. Purpose: To determine if baseline Landing Error Scoring System (LESS) scores are associated with the incidence rate of lower extremity stress fracture. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 1772 participants with no history of lower extremity stress fracture were included. At preinjury baseline, the authors conducted a lower extremity movement assessment during a jump-landing task using the LESS. Incident lower extremity stress fractures were identified during a 4-year follow-up period. Potential incident cases were reviewed by 2 sports medicine fellowship–trained orthopaedic surgeons blinded to baseline LESS data. Univariate and multivariable Poisson regression models were used to estimate the association between baseline total LESS scores, individual LESS items, and the incidence rate ratio (IRR) of lower extremity stress fracture. Results: A total of 94 incident lower extremity stress fractures were documented, for a 5.3% (95% CI, 4.3%-6.5%) cumulative incidence. The overall LESS score was associated with the incidence rate of lower extremity stress fracture. For every additional movement error documented at baseline, there was a 15% increase in the incidence rate of lower extremity stress fracture (IRR, 1.15 [95% CI, 1.02-1.31]; P = .025). In univariate analyses, ankle flexion, stance width, asymmetrical landing, and trunk flexion at initial contact, in addition to overall impression, were associated with the incidence rate of stress fracture. After controlling for sex and year of entry into the study cohort, participants who consistently landed flat-footed or heel-to-toe were 2.33 times (95% CI, 1.36-3.97; P = .002) more likely to sustain a lower extremity stress fracture. Similarly, participants who consistently demonstrated asymmetric landing at initial contact were 2.53 times (95% CI, 1.34-4.74; P = .004) more likely to sustain a stress fracture. Conclusion: Components of the LESS may be associated with increased lower extremity stress fracture risk and may be helpful in efficiently assessing high-risk lower extremity biomechanics in large groups.
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Affiliation(s)
- Kenneth L Cameron
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Karen Y Peck
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Steven M Davi
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Col Ret Brett D Owens
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA.,Brown University Alpert Medical School, Providence, Rhode Island, USA
| | - Col Ret Steven J Svoboda
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | | | - Stephen W Marshall
- John A. Feagin Jr. Sports Medicine Fellowship, Department of Orthopedic Surgery, Keller Army Hospital, United States Military Academy, West Point, New York, USA
| | - Sarah J de la Motte
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Col Ret Anthony I Beutler
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, Maryland, USA
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Lisman P, Wilder JN, Berenbach J, Jiao E, Hansberger B. The Relationship between Landing Error Scoring System Performance and Injury in Female Collegiate Athletes. Int J Sports Phys Ther 2021; 16:1415-1425. [PMID: 34909248 PMCID: PMC8637302 DOI: 10.26603/001c.29873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The Landing Error Scoring System (LESS) is a standardized tool used to identify aberrant biomechanical movement patterns during a jump-landing task. Prior authors have examined the value of the LESS in identifying ACL injury risk in athletic populations. Yet, no study has evaluated the association between LESS performance and incidence of any type of lower extremity injury in female collegiate athletes across multiple sports. PURPOSE The purpose of this study was to examine the association between LESS performance as measured with a markerless motion-capture system and lower extremity injury in female collegiate athletes. STUDY DESIGN Prospective cohort study. METHODS One hundred and ten DI female collegiate athletes (basketball, n=12; field hockey, n=17; gymnastics, n=14; lacrosse, n=27; softball, n=23; volleyball, n=17) completed a jump-landing test prior to the start of their sport seasons. The LESS was automatically scored using a Microsoft Kinect sensor and Athletic Movement Assessment software (PhysiMax®). Participants were tracked throughout one competitive season for incidence of time-loss lower extremity injury. A Receiver Operating Characteristic curve determined the optimal cutpoint for the total LESS score for predicting injury. Pearson's Chi squared statistics examined the association between injury and LESS total scores >5. The Fisher exact test evaluated group differences for the frequency of receiving an error on individual LESS test items. RESULTS Female collegiate athletes with LESS scores >5 were not more likely to be injured than those with scores ≤5 (χ2=2.53, p=0.111). The relative risk of injury to this group was 1.78 (95% CI=0.86, 3.68) while the odds ratio was 2.10 (95% CI=0.83, 5.27). The uninjured group was more likely to receive an error on lateral trunk flexion at initial contact than the injured group (p=0.023). CONCLUSION The LESS total score was not associated with an increased odds of lower extremity injury in this cohort of female collegiate athletes. Future studies to examine the association between individual LESS item scores and injury are warranted. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
| | | | | | - Enric Jiao
- Department of Kinesiology, Towson University
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Hanzlíková I, Athens J, Hébert-Losier K. Factors influencing the Landing Error Scoring System: Systematic review with meta-analysis. J Sci Med Sport 2020; 24:269-280. [PMID: 32951976 DOI: 10.1016/j.jsams.2020.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Systematically review the literature addressing age, sex, previous injury, and intervention program as influencing factors of the Landing Error Scoring System. DESIGN Systematic review with meta-analysis. METHODS Three databases (PubMed, Web of Science®, and Scopus®) were searched on 1 April 2020. Original studies using the Landing Error Scoring System as primary outcome and exploring age, sex, previous injury, and intervention program were included, assessed for risk of bias, and critically appraised. Three meta-analyses were performed using one random and two mixed effect models with dependent variables: sex, previous injury and intervention program, respectively. Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the strength of the evidence. PROSPERO registration number CRD42018107210. RESULTS Fifty-two studies were included. Pooled data indicated that females have higher Landing Error Scoring System scores than males (p<0.001, mean difference=0.6 error). Participants with previous anterior cruciate ligament injury have higher LESS scores than healthy controls (p=0.004, mean difference 1.2 error). Neuromuscular training programs lasting a minimum of six weeks and other intervention programs decrease Landing Error Scoring System scores (p<0.001, mean difference 1.2 error and p=0.042, mean difference 0.5 error, respectively). There is limited evidence suggesting that age may influence Landing Error Scoring System scores in clinically meaningful manner. Overall, Grading of Recommendations Assessment, Development and Evaluation ratings suggest very low strength of evidence. CONCLUSIONS History of anterior cruciate ligament injury and undertaking neuromuscular training for a minimum of six weeks meaningfully altered Landing Error Scoring System scores. These findings, however, should be interpreted cautiously considering the very low Grading of Recommendations Assessment, Development and Evaluation rating of the evidence.
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Affiliation(s)
- Ivana Hanzlíková
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, New Zealand.
| | - Josie Athens
- Department of Preventive and Social Medicine, University of Otago, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, Te Huataki Waiora School of Health, Adams Centre for High Performance, University of Waikato, New Zealand
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Schwartz O, Talmy T, Olsen CH, Dudkiewicz I. The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study. Clin Biomech (Bristol, Avon) 2020; 73:115-121. [PMID: 31982808 DOI: 10.1016/j.clinbiomech.2020.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 01/05/2020] [Accepted: 01/14/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces. METHODS All 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system - real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores. RESULTS The area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system - real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576). INTERPRETATION Based on the results of this study, the landing error score system - real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.
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Affiliation(s)
- Oren Schwartz
- Department of Day Care and Pain Unit, Reuth Rehabilitation Center, 2 Hachail Ave., Tel Aviv 6772829, Israel.
| | - Tomer Talmy
- IDF Medical Forces Headquarters, 1 Aharon Kazir St., Ramat-Gan 5262000, Israel
| | - Cara H Olsen
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20895, USA.
| | - Israel Dudkiewicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Rehabilitation, Sheba Medical Center, 2 Sheba Road, Tel Hashomer, Ramat Gan 5262100, Israel.
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Hanzlíková I, Hébert-Losier K. Is the Landing Error Scoring System Reliable and Valid? A Systematic Review. Sports Health 2020; 12:181-188. [PMID: 31961778 DOI: 10.1177/1941738119886593] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
CONTEXT The Landing Error Scoring System (LESS) is a clinical tool often used in research and practice to identify athletes presenting high injury-risk biomechanical patterns during a jump-landing task. OBJECTIVE To systematically review the literature addressing the psychometric properties of the LESS. DATA SOURCES Three electronic databases (PubMed, Web of Science, and Scopus) were searched on March 28, 2018, using the term "Landing Error Scoring System." STUDY SELECTION All studies using the LESS as main outcome measure and addressing its reliability, validity against motion capture system, and predictive validity were included. Original English-language studies published in peer-reviewed journals were reviewed. Studies using modified versions of the LESS were excluded. STUDY DESIGN Systematic literature review. LEVEL OF EVIDENCE Level 4. DATA EXTRACTION Study design, population, LESS testing procedures, LESS scores, statistical analysis, and main results were extracted from studies using a standardized template. RESULTS Ten studies met inclusion criteria and were appraised using Newcastle-Ottawa Quality Assessment Scale adapted for cross-sectional studies. The overall LESS score demonstrated good-to-excellent intrarater (intraclass correlation coefficient [ICC], 0.82-0.99), interrater (ICC, 0.83-0.92), and intersession reliability (ICC, 0.81). The validity of the overall LESS score against 3-dimensional jump-landing biomechanics was good when individuals were divided into 4 quartiles based on LESS scores. The validity of individual LESS items versus 3-dimensional motion capture data was moderate-to-excellent for most of the items addressing key risk factors for anterior cruciate ligament (ACL) injury. The predictive value of the LESS for ACL and other noncontact lower-extremity injuries remains uncertain based on the current scientific evidence. CONCLUSION The LESS is a reliable screening tool. However, further work is needed to improve the LESS validity against motion capture system and confirm its predictive validity for ACL and other noncontact lower-extremity injuries.
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Affiliation(s)
- Ivana Hanzlíková
- Division of Health, Engineering, Computing and Science, School of Health, Sport and Human Performance, University of Waikato, Tauranga, New Zealand
| | - Kim Hébert-Losier
- Division of Health, Engineering, Computing and Science, School of Health, Sport and Human Performance, University of Waikato, Tauranga, New Zealand
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Moon JW, Cho JH, Lim ST, Lim BO. Analysis of Landing Error Scoring System for Evaluating the Anterior Cruciate Ligament Risk Factors of Muscle Mass in Female. THE ASIAN JOURNAL OF KINESIOLOGY 2019. [DOI: 10.15758/ajk.2019.21.3.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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